| NPI | 1114914280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 16329) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35070360) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2010-03-17 |